Reproductive Health

Why is vulvar and vaginal health important?

Maintaining a healthy vulva and vagina will help prevent discomfort and potential infections. The vagina cleanses itself by producing normal discharge and keeping acidic pH levels, which makes it difficult for infectious organisms to thrive. However, most people will experience vaginal discomfort and infections (vaginitis) at some point in their lives. If you notice unusual vaginal discharge, it could be a sign of an infection. Treatment for the infection will vary depending on what is causing it. Some of the most common vaginitis are caused by fungal organisms (Yeast Infection) or bacterial organisms (Bacterial Vaginosis).

How do vaginal infections occur?

Vaginal infections can often occur when fungal or bacteria organisms grow unopposed, uncontrolled and when there is a pH imbalance. Some of these organisms already coexist in the vagina but are kept in balance resulting in normal, healthy levels of these organisms.  Another way for vaginal infections to occur is when infectious organisms are introduced during unprotected sex.

How to prevent vaginal infections?

• Use only water to cleanse the vulva and vaginal area.
• Avoid using vaginal douching, scented pads/tampons, soap, bubble baths, feminine hygiene sprays, talc powder, etc.
• Wear cotton underwear, which is a “breathable” fabric.
• Avoid acetate, nylon pantyhose or leggings as they trap and keep excessive heat and moisture.
• Remove wet bathing suits/gym clothes promptly.
• Rinse underwear carefully:  avoid too much laundry detergent or fabric softeners/dryer sheets.
• Do not leave a tampon in for a long period of time to avoid the risk for Toxic Shock Syndrome.
• Consume plain yogurt, which is rich in probiotics. If you are lactose intolerant, you may want to use probiotics capsules instead.

When to schedule an appointment with a Health Care Provider?

• If you notice an unusual change in your vaginal discharge (increased amount, different color, smell and/or if the discharge causes vulvar/vaginal burning, irritation, swelling, itching or pain).
• If you have pelvic pain and/or fever (F=100.4 or higher)
• If you think you could have been exposed to a Sexually Transmitted Infection (STI).

What is a Urinary Tract Infection?

A urinary tract infection (UTI) is either an infection of the lower urinary system involving the bladder and the urethra (cystitis) or has advanced from the bladder and urethra to the kidneys (pyelonephritis). Biological females are usually at greater risk of developing a UTI than males due to their anatomy: females have shorter urethras compared to males. If the infection is limited to the bladder, it causes discomfort and pain. If the infection spreads to the kidneys (pyelonephritis) it could cause more serious problems.

What are common symptoms of a UTI?

• Frequent urination (urinary frequency).
• Strong urge to urinate (urinary urgency).
• Painful, burning sensation with urination (dysuria).
• Only small amounts of urine produced (incomplete voiding).
• Blood in the urine (hematuria).
• Pelvic pain.
• Flank pain (with pyelonephritis).
• Fever (with pyelonephritis).

What to do to prevent a UTI?

• Keep yourself hydrated, drink plenty of water (8 glasses/day).
• Empty your bladder promptly after sexual intercourse. Always use barrier protection such as condoms.
• After using the restroom, use white, unscented toilet paper and wipe from front to back.
• Avoid thong underwear.
• If you have history of recurrent UTIs, cranberry pills may be used to aid in prevention.

When to schedule an appointment with a Health Care Provider?

• If you have frequent, painful urination.
• If you have urinary urgency and incomplete voiding.
• If you notice pelvic pain.
• If you notice flank pain (lower back pain towards the sides) blood in the urine or fever (F=100.4 or higher) as these could be signs of a kidney infection.
• If you think you could have been exposed to a Sexually Transmitted Infection (STI).

What is STI Screening, Exactly?

Getting a screening test means that we look for an infection when you may not have any symptoms. There are no exact recommended times or tests that we recommend for everyone. These testing recommendations depend on your lifestyle and risk level.

Why Is It Important to Get Tested for STIs?

Most importantly, get tested to protect yourself, your partner(s), and to stay informed.  Making a diagnosis can alert you to an infection you may not know you had (e.g. many people with hepatitis C, probably about 1 million in the U.S., have no idea they have been infected), or that may have long-term effects like infertility. It can also allow you to start treatment if you do have an infection, and create peace of mind when you think you may have been at risk.

What Are the Most Common STIs?

• Gonorrhea and Chlamydia: These infections are very common and are often grouped together because they’re screened for at the same time. The infection can be missed, particularly in biological females because the bacteria that cause them doesn’t always create symptoms. Infections are caused by oral, anal, or genital contact with someone else who has an infection.
• Syphilis: Syphilis is a bacterial infection passed from one person to another by oral, anal, or genital contact with infectious but painless sores that are present during the initial stages of the infection.
• Herpes: There are two strains of the herpes virus: type 1 and type 2. Type 1 has traditionally been associated with oral herpes (cold sores) and type 2 with genital herpes, but research has shown that genital infections may also be caused by type 1.  A person may have either strain of the virus but never show any symptoms, or may have an “outbreak” with painful sores near his or her mouth, genitals, or anus. Herpes is most commonly transmitted via contact with infectious sores, but in some cases can be transmitted when the infected person has no symptoms at all. Because a person can be contagious even though no lesions are present, taking precautions only when there are visible lesions may not prevent spread of the infection to the partner.
• HIV: This viral infection is transmitted via blood (e.g, in intravenous drug abusers who share needles with infected persons) or sexually, by having unprotected anal or vaginal sex. Very rarely, it can be transmitted by contact with other body fluids.
• Human Papillomavirus (HPV): The most common STI in the U.S., this virus causes genital warts, although the lesions don’t appear in everyone who has HPV. It’s highly contagious and easily transmitted sexually or even by skin-to-skin contact. When genital warts are present, we can usually make a diagnosis from inspection, but additional testing is sometimes useful in women who have had an abnormal pap smear.
• Hepatitis C (PDF): Hepatitis C is a viral infection that is transmitted most commonly through contact with blood or through skin exposure (e.g., sharing needles/cocaine straw or coming into contact with an open wound or sore). Very uncommonly, hepatitis C can be contracted by having sex with someone who has hepatitis C; the risk is about 1 transmission per 190,000 sexual occurrences. This infection can cause chronic liver disease and liver cancer.

What Types of Tests Are Out There?

There are plenty of tests that make staying informed accessible, but there’s no single test for every STD. Most tests require a urine or blood sample, or a swab of the area where the infection might be present. If you have a sore and we want to pinpoint the cause, a swab can additionally identify whether a specific virus or bacteria is present.

What Should I Be Tested for and When?

People often say, “Just test for everything.” While that might seem to make sense initially, it’s important to talk to your health care provider about your specific risk factors and lifestyle. There are a few downsides to testing for everything that are important to consider. First of all, tests are expensive, and in a few cases, such as blood testing for herpes, a positive test can be a false positive. False positives may result in unnecessary anxiety when there may be virtually no risk of transmission and no required treatment.

Here are some instances that would prompt a screening test:

• You’re sexually active. Everyone who is sexually active (even if you’ve only ever had one partner and always use protection) should be screened at some point. We recommend an HIV test for everyone who is sexually active. We also suggest all patients at risk obtain a test for gonorrhea and chlamydia.  It is recommended that all biological females aged 24 and younger who are sexually active to have a chlamydia and gonorrhea test annually or if they have had a new sexual contact.
• You’re having unprotected sex.  If you’ve had or want to start having sex — vaginal, anal, or oral — with a new partner it’s a good idea to get tested. Here’s how long after exposure can we obtain a reliable test result:
  • Chlamydia and Gonorrhea – Usually one week after exposure to be positive.
  • Syphilis – Four to six weeks after exposure
  • HIV – As early as fourteen days after exposure but could take up to 6 weeks.
  • (You might be asking, “What about herpes?” We don’t recommend screening for the herpes virus for most people unless you have an outbreak of sores.)
• You engage in high-risk sexual behavior.  If your partner has a chronic or long-term infection such as HIV or hepatitis B or C, it’s important to be tested more frequently. Additional high-risk behavior includes intimate contact with a sex worker, IV drug user, men who have sex with men, and having multiple partners, or anonymous partners. In these cases, you’re at higher risk for coming into contact with HIV and hepatitis C, along with syphilis, gonorrhea, and chlamydia and should get tested after contact (that includes oral and anal sex).
• You’ve had an infection in the past. You may be more likely to have an infection again, so it’s recommended  to be screened about 3 months after you’ve been treated.
• You have symptoms. This is a good time to have a discussion with your health care provider. Your symptoms and history will allow you to make the best choice about the most informative tests to look for possible causes of your symptoms.

STI testing is available at the SHC 

Call (707) 664-2921 to make an appointment. It is quick, easy, and confidential. Depending on which infection is being tested for, different types of samples are required. This may include urine samples, vaginal/rectal/throat swabs, and/or blood draws.

Visit Pregnancy for information on pregnancy resources and relevant SHC services.

Visit Medication Abortion for information on medication abortion services offered at the SHC.